Woman with impaired balance when walking

A 30-year old woman had been well until recently when, following a flu-like illness, she developed a tremor of her arms and impaired balance when standing or walking. Other studies failed to disclose any abnormalities.

These symptoms lasted a week, but then she recovered. Eighteen months last, she experienced another episode of weakness and required assistance when walking. At this time she also complained of blurred vision. She was referred to a neurologist who found ataxia, dysarthria, decreased vibratory sensation in her legs, absent abdominal reflexes, increased deep tendon reflexes, and a Babinski sign on the left. Subsequently her illness was characterized by remissions and exacerbations, but overall was slowly progressive. She became bedridden 15 years after the onset of the disease, and she developed a neurogenic bladder. She was subsequently rehospitalized with a high fever and died of sepsis.

The correct answer is C. Multiple sclerosis. There were a total of 19 responses. A breakdown of responses are inside the parentheses below.

The most likely diagnosis is:

A. Alzheimer disease (0)
B. Huntington disease (1)
C. Multiple sclerosis (15)
D. Poliomyelitis (3)
E. Rabies (0)

(see results graphically)